Screening-positive attention-deficit/hyperactivity disorder symptoms among incarcerated individuals in Paraguay: prevalence, psychological correlates, and criminological context

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms are frequently reported among incarcerated populations and have been associated with impulsivity, emotional dysregulation, and adverse mental health outcomes. Despite growing international evidence, no previous studies have examined screening-positive ADHD symptoms among prisoners in Paraguay or evaluated Spanish-language screening tools in correctional settings. Aim: To estimate the prevalence of screening-positive ADHD symptoms among incarcerated men and women in Paraguay, examine selected psychological and criminological variables, and assess the reliability and factorial structure of the Spanish version of the Symptom Check List-ADHD (SCL-ADHD). Methods: This cross-sectional study included 836 inmates (621 men, 215 women) recruited through probabilistic sampling in three Paraguayan prisons. Screening-positive ADHD status was defined as a score ≥ 12 on the nine-item SCL-ADHD derived from the SCL-90-R. Psychiatric symptoms, suicide risk, and substance-related problems were assessed using validated measures. Multivariable logistic regression identified independent correlates of screening-positive ADHD status. Results: Screening-positive ADHD status was observed in 33.4% of participants, with higher prevalence among women than men (39.1% vs. 31.4%; OR = 1.40, 95% CI 1.02-1.93, p = 0.04). Screening-positive ADHD was independently associated with suicide risk (OR = 3.85, p < 0.001) and elevated SCL-90-R dimensions of hostility, anxiety, depression, and obsessive-compulsive symptoms. Sensitivity analyses using continuous symptom scores showed associations with hostility, anxiety, and obsessive-compulsive symptoms remained, whereas association with depression attenuated. No significant independent associations were observed with criminological variables. The Spanish SCL-ADHD demonstrated acceptable internal consistency (α = 0.76) and a coherent symptom structure. Conclusion: Screening-positive ADHD symptoms were common among incarcerated individuals in Paraguay, particularly women, and were associated with concurrent emotional dysregulation and suicidality. These findings reflect screening-based symptom burden rather than confirmed adult ADHD diagnoses and highlight the potential utility of systematic ADHD screening within correctional mental health services.